MEDICARE: COAST TO COAST THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1255273447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COAST TO COAST THERAPY LLC

Provider Business Mailing Address
First Line	:	746 CHERRY ELM DR
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32092-0136
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	746 CHERRY ELM DR
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32092-0136
Country	:	US
Telephone Number	:	516-497-2259
Fax Number	:

Authorized Official
Title or Position	:	OWNER/SPEECH PATHOLOGIST
Name	:	SAMANTHA LYNN INCAMPO
Credential	:
Telephone Number	:	516-497-2259

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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Directions to “COAST TO COAST THERAPY LLC ” Practice Location

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